MUSCOSKELETAL DISORDER

CRUCIATE LIGAMENT
1. COMMON IN:
  1. LARGE BREED DOGS
  2. MAY HAVE HISTORY OF TRAUMATIC FALL/ TWIST
    1. 70% DO BOTH
  3. 10/10 LAME WITH TOE TOUCHING
2. PARTIAL TEARS MAY RECOVER BUT FULL TEARS FIBROSE. MENISCAL INJURY STAY LAME
3. FIBROUS BAND TISSUE ATTACH FEMUR AND TIBIA, PREVENTING CRANIAL SHIFTING AND OVER EXTENSION OF STIFLE
  1. CRANIAL DRAWER TEST: PUSH TIBIA FORWARD WHILST FEMUR STILL: PAINFUL
  2. TIBIAL THRUST TEST- LESS PAINFUL. HOLD STIFLE OVER FEMUR, FLEX HOCK AND TIBIA WILL SLIP CRANIALLY PAST FEMUR
  3. RADIOGRAPHY TO SEE COMPRESSION OF PARA-PATELLA FAT PAD, POSITION OR DEGENERATIVE JOINT PROBLEMS; SEDATE/ANAESTHETISE AND PERFORM FULL EXAM.
  4. ARTHROSCOPY: MENISCUS AND LIGAMENTS
  5. DIFFICULT TO RISE, POTTERY GAIT, SOMETIMES CAN NOT RISE AT ALL. MAY MISTAKE FOR SPINAL PROBLEM
4. SURGERY
  1. TIBIAL PLATEU LEVELLING OSTEOTOMY
  2. TIBIAL TUBEROSITY ADVANCEMENT
  3. MODIFIED MAQUET PROCEDURE
  4. TOTAL KNEE REPLACEMENT
    1. LAST RESORT AS MANY COMPLICATIONS
  5. DE ANGELIS OR LATERAL SUTURE LIGAMENT REPLACEMENT
5. CONSERVATIVE
  1. SMALL BREEDS RESTED FOR 6 WEEKS
  2. JOINT FIBROSE AND STIFFEN, REDUCING CRANIAL DRAWER AND PAIN
  3. COMPLEMENTARY THERAPY
  4. SURGERY MAY HAVE COMPLICATIONS AND RISK OSTEOARTHRITIS
SKELETAL DISORDERS
1. INFLAMMATORY/ INFECTIOUS
  1. OSTEOMYELITIS
    1. USUALLY INFECTION
      1. C&S
      2. ANTIBIOTICS/ ANTIFUNGALS, REMOVAL OF SURGICAL IMPLANTS, DEBRIDEMENT AND SEQUESTRIUM REMOVAL
    2. PAIN, PYREXIA, SWELLING, LAMENESS OR LOSS OF FUNCTION, DEPRESSION, INAPPETANCE, DRAINING SINUS TRACT MAY DEVELOP
    3. RADIOGRAPHY (BONE DESTRUCTION AND NEW FORMATION)
    4. MONITOR VITALS, ANALGESIA, ADMINISTER MEDS, SOFT COMFORTABLE BEDDING, POST-OP CARE, MANAGE AND CHANGE DRESSINGS
  2. ARTHRITIS
    1. IMMUNE MEDIATED
      1. IDIOPATHIC POLYARTHRITIS, RHEUMATOID ARTHRITIS
      2. PYREXIA, MULTIPLE JOINTS, SYSTEMIC DISEASE SIGNS
    2. INFLAMMATORY/ SEPTIC?
      1. JOINT PAIN, SWELLING, PYREXIA, RECENT SURGERY/ MEDICATION
    3. DEGENERATIVE JOINT DISEASE
      1. GRADUAL, AGE RELATED ONSET
        CREPITUS
      2. EXERCISE IMPROVES
      3. USUALLY SECONDARY, DISEASE OF CARTILAGE AND JOINT FLUID
      4. MATRIX METALLOPROTIENASES BREAK DOWN CARTILAGE
      5. BONES CONTACT EACH OTHER
        PAIN, REMODELLING AND NEW BONE GROWTH
        INTERLEUKIN-1 STIMULATES MMP SECRETION BY CHONDROCYTES.
        PIECES BREAK OFF= JOINT MICE
2. DEVELOPMENTAL
  1. RICKETS
    1. YOUNG GROWING ANIMALS WITH VITAMIN D +/- CALCIUM DEFICIENCY
    2. INABILITY TO ABSORB CA FROM GIT RESULTING IN DECREASED BONE MINERALISATION ESPECIALLY AT GROWTH PLATES
    3. LAMENESS, BOW LEGS, SWOLLEN JOINTS, HISTORY AND RADIOGRAPH
    4. BALANCED PUPPY DIET, ANALGESIA, SOFT, COMFORTABLE BEDDING, ENSURE URINATION/ DEFECATION POSSIBLE
  2. OSTEOCHONDROSIS
    1. SELF-LIMITING DEVELOPMENTAL DISORDERS OF YOUNG, GROWING ANIMALS DUE TO ASEPTIC, ISCHAEMIC NECROSIS WITHIN BONES
    2. COMMON AT SHOULDER, ELBOW, STIFLE, TARSUS/HOCK
  3. METAPHYSEAL OSTEOPATHY (HYPERTROPHIC OSTEODYSTROPHY OR MOLLER BARLOWS DISEASE)
    1. YOUNG, GROWING ANIMALS ESPECIALLY GIANT BREEDS AND WESTIES
    2. ABNORMAL METAPHYSEAL BONE FORMATION, TYPICALLY LONG BONES OF DISTAL LIMBS BUT AETIOLOGY UNKNOWN
    3. SEVERE LAMENESS, ANALGESIA, SOFT BEDDING, ENSURE DEFECATION AND URINATION POSSIBLE
  4. SECONDARY NUTRITIONAL HYPERPARATHYROIDISM
    1. GROSS DIETARY CALCIUM DEFICENCY OR EXCESS PHOSPHORUS E.G ALL MEAT DIET
    2. BONE RESORPTION CAUSING PAIN AND LAMENESS, RELUCTAMCE TO STAND/ WALK, PATHOLOGICAL FRACTURES
    3. BALANCED DIET, ANALGESIA, SOFT COMFORTABLE BEDDING, ENSURE URINATION, DEFECATION POSSIBLE
JOINT DISORDERS
1. STIFLE
  1. LUXATING PATELLA WESTIES
  2. COLLATERAL LIGAMENT DAMAGE FROM TWISTING INJURIES (RABBIT HOLES)
  3. TIBIAL GROWTH PLATE FRACTURES IN YOUNG DOGS
2. HIP DYSPLASIA
  1. ANIMALS AS THEY GROW, FEMORAL HEAD WEARS AWAY ACETABULUM RESULTING IN INCREASED LAXITY, PAIN, LIMB DYSFUNCTION AND PROGRESSIVE JOINT CHANGES. CARTILAGE LOSS, SCAR TISSUE AROUND JOINT, OSTEOPHYTES
    1. MANAGEMENT
      1. DEPENDS ON WEIGHT, MASS, AGE, DEGREE OF DISCOMFORT, SIZE. EXAMINATION AND X-RAY FINDINGS, OWNER EXPECTATIONS AND BUDGET
      2. AGGRESSIVE WEIGHT LOSS, LITTLE AND OFTEN LOW IMPACT EXERCISE (HYDRO) NSAIDS, PHYSIOTHERAPY, FISH OIL AND OMEGA 3-6 SUPPLEMENTS, NUTRACEUTICALS; GLUCOSAMINE CHONDROITIN, DISEASE MODIFYNG OA DRUGS
        CARTROPHEN; PENTOSAN POLYSULPHATE SODIUM= SUGAR WITH ACTIONS SITES IN ALL JOINTS. IMPROVES JOINT FLUID, REDUCE CARTILAGE DESTRUCTION AND INCREASE REPAIR
    2. SURGERY
      1. DOUBLE OR TRIPLE PELVIC OSTEOTOMY (DPO/ TPO)
        PELVIC BONE CUT IN 2-3 PLACES AND ROTATED PROVIDED BETTER FEMORAL HEAD COVERAGE, REDUCING LAXITY
      2. TOTAL HIP REPLACEMENT
        BALL AND SOCKET REPLACED WITH METAL AND POLYETHYLENE IMPLANTS. BONE CEMENT FIXES IN PLACE. METAL PEGS OR PRESS FIT (BONE INGROWTH METHODS)
      3. FEMORAL HEAD AND NECK EXCISION
        LIMIT BONY CONTACT TO ALLOW FIBROUS JOINT AND SCAR TISSUE DEVELOPMENT. RELIEVES PAIN. FOR SMALL DOGS AND CATS
  2. LAMENESS, RELUCTANCE STAND/ JUMP, LOSS OF MUSCLE MASS, HIP PAIN
  3. MULTIFACTORIAL CAUSES, GENETICS, RAPID WEIGHT GAIN. LARGE BREEDS AND MINIATURE POODLES.
3. OTHER HIP AND PELVIC PROBLEMS
  1. PELVIC FRACTURES (CAT RTA); IF NEUTERED AND ABLE ELIMINATE, CONSERVATIVE MANAGEMENT
  2. TRAUMATIC HIP LUXATIONS IN POODLES AND CATS; LONGER OUT = LESS CONSERVATIVE SUCCESS
    1. GA TO POP BACK IN, EHMER SLING AND REST
    2. SURGERY IF RELUXATES
4. ELBOW DYSPLASIA
  1. FRAGMENTATION AND INSTABILITY (MEDIAL CORONOID PROCESS FRAGMENTS AND UNUNITED ANCONEAL PROCESS LEADING TO OCD)
    1. LAMENESSS, RELUCTANCE TO RISE/ JUMP. LOSS OF MUSCLE MASS
    2. MANAGEMENT
      1. MULTIMODALITIES, AGGRESSIVE WEIGHT LOSS, LITTLE AND OFTEN LOW IMPACT EXERCISE, NSAIDS, FISH OILS, DISEASE MODIFYING OSTEOARTHRITIS DRUGS
    3. SURGERY
      1. SLIDING HUMERAL OSTEOTOMY; REALIGNS LIMB REMOVE PRESSURE FROM DAMAGED CARTILAGE, ALLOWING TO HEAL AND RELIEVE GRINDING PAIN
      2. ARTHRODESIS= FUSE JOINT AS LAST RESORT
      3. ARTHROSCOPY TO REMVE FRAGMENTS
  2. GENETICS, GROWTH RATE, DIET AND EXERCISE LEVEL EFFECT SEVERITY. MEDIUM TO LARGE BREED DOGS
MUSCLE INJURIES/ DISORDERS
1. MYOPATHIES
  1. INFLAMMATORY
    1. TRAUMA (STRAINS/ RUPTURES), INFECTIOUS (TOXOPLASMA GONDII, NEOSPORA CANINUM, SARCOCYSTIS SPP)
    2. IMMUNE MEDIATED; MYASTHENIA GRAVIS
      1. NEUROMUSCULAR TRANSMISSION DISORDER CAUSING MUSCLE WEAKNESS AND EXCESS FATIGUE.
      2. STRUCTURAL/ FUNCTIONAL ABNORMALITIES OF ACETYCHOLINE RECEPTORS (CONGENITAL)OR AUTO IMMUNE ACETYLCHOLINE RECEPTOR DESTRUCTION. AFFECTS RESPIRATORY AND SKELETAL MUSCLE
        ANTICHOLINERASE DRUGS TO PROLONG ACTION OF ACH AT NEUROMUSCULAR JUNCTION. CORTICOSTEROIDS.
        RESOLUTION WITHIN 4-6 MONTHS IF NO SEVERE ASPIRATION PNEUMONIA OR PHARYNGEAL WEAKNESS
        CONGENITAL IN JACKS, SPRINGERS, SMOOTH FOX TERRIER,
        RECESSIVE. SEEN AT 6-8 WEEKS. RARE
  2. NON-INFLAMMATORY
    1. CONGENITAL (FLOPPY LABRADOR SYNDROME/ EXERCISE INDUCED COLLAPSE), ENDOCRINE (CUSHINGS) ATROPHY DUE TO TRAUMATIC INJURY?
2. MUSCLE/ TENDON STRAINS
  1. ACUTE EASILY DIAGNOSED
    1. SUDDEN ONSET LAMENESS, FOCAL PAIN +/- MUSCLE TENSION, HEAT/SWELLING
  2. CHRONIC; ULTRASOUND? SCINTIGRAPHY? THERMOGRAPHY
  3. PECTORALS, BICEPS BRACHII, BRACHIOCEPHALICUS, GLUTEALS, GRACILLIS, THE SEMI'S, BICEPS FEMORIS, GASTROCNEMIUS +/- SARTORIUS
    1. REST, NSAIDS, PHYSIOTHERAPY
3. MUSCLE RUPTURES/TEARS
  1. PINCHED, STRETCHED OR DIRECT INJURY CAUSING FIBRE DISRUPTION, WEAKENING AND IMMEDIATE OR DELAYED SEPARATION OF UNINJURED PORTION.
    1. REST, COLD APPLICATION THEN HEAT, PASSIVE ROM, ANALGESIA, NSAIDS, SURGERY
  2. LIMB OR MASTICATORY MUSCLES, ACUTE OR CHRONIC
  3. SUDDEN ONSET LAMENESS, FOCAL PAIN/ INFLAMMATION, +/- MUSCLE TENSION LOCALISED HEAT AND SWELLING
  4. ULTRASOUND, THERMOGRAPHY, SCINTIGRAPH
SPINAL DISORDERS
1. DISC DISEASE 'SLIPPED DISC'
  1. FIBROUS PULP WITHIN DISC PROTRUDES/ HERNIATES INTO SPINAL CANAL
    1. SURGERY OR CONSERVATIVE MORE SUCCESSFUL EARLIER IDENTIFIED. SURGERY SLIGHTLY BETTER
  2. GRADUAL OR ACUTE WITH ANIMAL PARALYSED WITHIN HOURS
  3. STAGE 1: MILD PAIN, USUALLY SELF-CORRECTING WITHIN A FEW DAYS
  4. STAGE 2: MODERATE TO SEVERE PAIN IN NECK OR LUMBAR AREA.
  5. STAGE 3: PARTIAL PARALYSIS / PARIESIS CAUSING STAGGERING AND LACK OF CO-ORDINATION
  6. STAGE 4: PARALYSIS AND ABILITY TO FEEL PRESENCE
  7. STAGE 5: PARALYSIS AND LOSS OF FEELING
2. DEGENERATIVE DISC DISEASE
  1. DISC LOSES MOISTURE IN NUCLEUS AND OUTER LAYER DRIES AND CRACKS, USUALLY CERVICAL
    1. DACHSHUNDS
    2. CAGE REST 4-6 WEEKS, MENTAL STIMULATION, LIGHT DIET TO MANAGE WEIGHT; MUSCLE ATROPHY!
  2. ACUTE= COMPLETE PARALYSIS IN HOURS
  3. CHRONIC= NO SIGNS BUT PAIN
3. CERVICAL DISC DISEASE
  1. HANSEN TYPE 1: EXTRUSION OR HERNIATION OF INNER VERTEBRAEL DISC CONTENTS IN SMALL BREEDS DUE TO DEGENERATION OF THE OUTER LAYER AND MINERLISATION OF THE INSIDE.
  2. HANSEN TYPE 2: SLOW/ GRADUAL DEGENERATIVE PROCESS LEADING TO CHRONIC BULGING OF DISC CONTENTS ON SPINAL CORD. OLDER DOGS
4. CAUDA EQUINA SYNDROME
  1. COMPRESSION OF NERVE ROOTS LEADING TO URINARY INCONTINENCE AND CHRONIC PAIN
  2. UNLIKELY TO RECOVER
5. FIBROCARTILAGINOUS EMBOLISM
  1. BITS OF BONE BREAK OFF, CUTTING OFF FLUID FLOW TO NERVES (CLOT)
  2. SUDDEN, REMOVE CLOT? PHYSIO?
6. DISCOSPONDYLITIS
  1. INFECTION OF VERTEBRAE AND DISCS
  2. DOBERMANS, NARROWS DISC SPACES
  3. BACTERIAL; LONG TERM ANTIBIOTICS, PAIN PROBLEMS
7. SPINAL FRACTURE
  1. FUSE OR PLATE IF NO CORD DAMAGE
  2. X-RAYS
8. CERVCAL SPONDYLOMYELOPATHY: DOBERMANS
9. PROBELMS
  1. ANYTHING COMPRESS SPINAL CORD AFFECT NERVE FUNCTION
    1. ATAXIA, WEAKNESS, INSTABILITY
  2. ASCENDING PATHWAYS DETECT MOVEMENT, PROPRIOCEPTION, NOCIOCEPTION
  3. DESCENDING PATHWAYS CONTROL MOVEMENTS
  4. TREAT WITH HYDROTHERAPY (TREADMILLS), TO IMPROVE PROPRIOCEPTION AND NORMAL GAIT DEVELOPMENT

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MUSCOSKELETAL DISORDER

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